The following is an abridged power point excerpt from a lecture I heard in Chicago in June. It is specifically about SCI but can be extrapolated to other serious life altering events as well such as CVA, Burns and TBI to name a few.
Facilitating Adjustment to Spinal Cord Injury: The Power of the Team
Jeri Morris, Ph.D. Senior Consultant RIC
& Faculty, NW School of Medicine
The typical inpatient stay is relatively short considering life altering event of SCI. Do not D/C people home if they discuss suicide or injury is result of an attempt.
Patient in shock & disbelief and denial of permanence of disability: usually denial is temporary but sometimes it’s serious (god will hear me and fix it, medicine will find a cure…)
There are many questions with few answers: everything is a problem.
 
How Does a Patient Get Labeled a Management Problem?
Poor motivation
Refusal of service
Depression leads to poor follow through and self care
Anger towards treatment team (i.e. we are not curing them)
Patients are frightened, not angry.  They are dealing with their anger and our own.
 
What Happens With The Team?
There is a difference between “hoping” and “expecting” for patient and team.
Team must not collude with denial of patient. Affirm and state your intention such as “I see your hoping that (the disability) will not persist, and we hope that as well, but do not expect that to happen, so in order to be prepared we need to…..”
Team members must support patient hearing the truth from the doctor and the doctor saying the truth to the patient.
Progress is severely hindered if patient is in denial
Don’t take away hope.
 
How Do We Help The Patient?
Get then to the point where their disability is no longer focus of life.
What changes might they have to make (what to keep, what to change, what to give up).
Get on the side of patient
Develop a relationship of trust
Operate from a position of benevolence
 
How To Help Ourselves
Understand why patients are being difficult
Be prepared to deal with patient anger and other negative reactions
Have realistic goals for ourselves
Support each other
Together, even in a short time, the team can have a meaningful impact on successful adjustment, one patient at a time